Volume 9, Issue 2, April 2025

An in-depth examination of existing evidence comparing laparoscopic and open repair of perforated peptic ulcer demonstrates that current evidence is based on small, single-centre randomized clinical trials, using heterogenous interventions and comparators, poorly described co-interventions, and outcomes of limited patient importance. Consideration of how intervention components and co-interventions should be optimally delivered is required to facilitate a well-designed trial.

The metaverse is an emerging concept in surgery, with much interest in its highly immersive and interactive virtual environment. Its applications in surgery are broad ranging, including education and training, surgical planning, and the delivery of surgical care.

Practicing evidence-based medicine requires that the patients we encounter in daily practice are represented in the populations recruited to randomized clinical trials. In our work, we show that incompleteness of vascular surgery RCT reporting on patient data limits the applicability of their findings.

This comprehensive systematic review and meta-analysis of nine trials and 1194 patients comparing neoadjuvant treatments to upfront surgery demonstrates improved overall survival in neoadjuvant treatment arms. This benefit is pronounced in borderline-resectable patients but there is no difference between chemotherapy and chemoradiotherapy. R0 and N0 rates are improved whilst surgical complications and significant adverse effects are comparable.

The resection rate for pancreatic cancer may improve survival of the overall pancreatic cancer population, potentially through optimizing adjunctive care. Defining a benchmark for resection rate aligns with patient-centred healthcare and may ensure equitable access to high-quality pancreatic cancer care.

The advantages of robotic hepatectomy for laparoscopic hepatectomy remain unclear and require clarification. This is the largest meta-analysis on this topic, with the largest number of patients; it is also the first meta-analysis to compare robotic hepatectomy with laparoscopic hepatectomy in patients with different difficulty levels of hepatectomy to date. The robotic approach has significant advantages over laparoscopic in surgical outcomes, especially in terms of lower blood loss and conversion to open.

According to our meta-analysis, circular staplers with a large diameter, manual technology, and the double-stapling technique are associated with a higher anastomotic leakage rate after left colorectal surgery, while no significant difference was observed between two- and three-row circular staplers. The importance of these findings lies in their relevance for selecting the appropriate type of circular stapler in left colorectal surgery.

This systematic review and meta-analysis investigates the incidence of postoperative venous thromboembolism (VTE) during the COVID-19 pandemic, revealing significantly higher rates in patients with perioperative COVID-19 compared with those without. Data from 17 studies involving >3 million patients showed VTE rates were raised in those undergoing total joint arthroplasty, other orthopaedic surgery, and emergency general and gastrointestinal surgery. The findings underscore the need for further research to understand VTE risk variations related to COVID-19 variants and vaccination.

Patients who have gastrectomy often experience postprandial hypoglycaemia, late dumping syndrome, and night-time hypoglycaemia. The aim of our study was to reveal the preventive effect of a low-carbohydrate/high-monounsaturated fatty acid (LC/HM) formula on post-gastrectomy hypoglycaemia and glycaemic variability. Active intake of the LC/HM formula improved post-gastrectomy night-time hypoglycaemia, but not daytime glycaemic variability or hypoglycaemia.

In a register-based cohort study, we investigated colonic resection and/or stoma formation in patients with chronic diverticular disease. Of 33 951 patients, the 5-year cumulative incidence proportion of surgery overall was 13.9% (elective 9.8%, emergency 4.2%). Predictors for surgery overall included complicated disease and, for elective surgery specifically, low age, no co-morbidity and increasing number of emergency admissions.

When feasible, limiting the extent of aortic replacement for acute type A aortic dissection may be beneficial in reducing mortality and major complications both in the short and long term.

This population-based cohort study represents the largest report to date on the implementation of prophylactic stomas before neoadjuvant therapy in rectal cancer. While these stomas are commonly used, they may result in increased morbidity before resection, including severe complications directly attributable to the stoma surgery.

This before-and-after study investigated whether a standardized transition of care bundle with a focus on discharge awareness and multidisciplinary information could enhance health-related quality of life (HRQoL), reduce readmission rates and increase days alive and at home (DAOH) after major emergency abdominal surgery. A total of 667 patients were included and we found HRQoL was significantly higher in the after group compared with the before group at postoperative day 30, 90 and 180. No difference in DAOH or readmission was found between the groups.

Further evidence to support survival benefit associated with conservation surgery and radiotherapy compared with mastectomy. This article demonstrates similar survival benefit amongst a subgroup of patients undergoing oncoplastic breast-conserving surgery and the findings should guide conversations with breast cancer patients regarding treatment options.

This article shows the differences in the characteristics of early-onset colorectal cancer between regions in Europe. Differences include: the age of onset, the prevalence of overweight/obesity and family history of colorectal cancer. Specific regional approaches are required to understand, prevent and manage early-onset colorectal cancer.

A real-time deep learning system was developed to identify extrahepatic bile ducts during indocyanine green fluorescence-guided laparoscopic cholecystectomy. The YOLOv7 model, trained on 3993 images, demonstrated a mean average precision of 0.846 in single-frame validation and estimated accuracies of 94.39% for the common bile duct and 84.97% for the cystic duct in video clip validation. This model could potentially assist surgeons in identifying critical landmarks, thereby minimizing the risk of bile duct injuries during laparoscopic cholecystectomy.

In this national cohort study of patients with rectal cancer and inflammatory bowel disease, the recurrence-free survival was time dependent. Despite lower recurrence-free survival during the first year among those with inflammatory bowel disease there were no long-term differences between patients with or without inflammatory bowel disease. Neoadjuvant radiotherapy/chemoradiotherapy was used to the same extent in both groups.

This study estimated the yearly incidence of major lower limb amputation in England over 10 years, overall, by conditions and by regions, while exploring reasons for regional variations. Overall incidence fell by 30%, with similar declines for those with diabetes, but a 20% increase was observed for individuals with both diabetes and cardiovascular disease. Significant regional variation was found, being highest in the North East and lowest in the East of England, remaining after adjustment for demographic, socioeconomic data and related conditions, thus indicating the need to investigate differences in service provision and accessibility.

This study determined that sarcopenia (incorporating muscle strength parameters), myosteatosis, and frailty are major determinants of functional compromise, feasible to measure before surgery, and predict adverse patient-centred and functional outcomes for older patients after emergency laparotomy. Muscle strength is more important than mass, and measurable without imaging, streamlining its clinical application.

This Swedish population-based cohort study showed similar survival and surgical outcomes after gastrectomy with omental preservation compared with gastrectomy with omentectomy. These results suggest that omentectomy can be omitted for patients with gastric cancer undergoing curative-intent gastrectomy.

Postmastectomy radiotherapy (PMRT) impairs the outcome of immediate breast reconstruction in patients with breast cancer, and the sentinel lymph node (SLN) status is crucial in evaluating the need for PMRT. In this study, the authors present two nomograms for evaluation of SLN status before surgery indicating the need for PMRT using clinicopathological characteristics. By offering personalized risk assessments, the models facilitate shared decision-making, guiding discussions on breast reconstruction options, and enabling patients with breast cancer to make more informed decisions about their reconstructive plans.

This study analysed current outcomes after resection for perihilar cholangiocarcinoma in a large bi-institutional Western–Eastern cohort to identify prognostic factors. Advanced tumour stage and radial margin positivity were found to contribute to poor long-term survival in the Western cohort. A higher burden of co-morbidity and a higher rate of extended resections with smaller remnant liver volume influenced the Western postoperative mortality rate.

In a cohort of 8118 adult patients, 1.5% experienced a postoperative venous thromboembolism. Enhanced Recovery After Surgery compliance is associated with decreased odds of postoperative venous thromboembolism across multiple surgical disciplines.

This large multicentre study of 1968 patients who underwent hepatic resection for HCC with curative intent demonstrated that the French AFP model outperformed the widely used Milan criteria in predicting post-resection recurrence and survival.

Non-operative management for blunt splenic injuries, including splenic artery embolization, is preferred, but its long-term risks need further investigation. Long-term infection, malignancy, thromboembolism, and all-cause mortality risks were not significantly different between the splenic artery embolization and conservative treatment groups. In contrast, patients who underwent splenectomies had increased infection, malignancy, thromboembolism, and all-cause mortality risks.

Compared with the former interval (2010–2015), the postoperative morbidity rate and early recurrence decreased, and overall survival and postrecurrence survival prolonged in the latter interval (2016–2021) for pancreatic cancer patients with arterial involvement undergoing pancreatectomy including arterial resection. Within the context of modern multidisciplinary treatment, radical resection including arterial resection can be justified for pancreatic cancer patients with arterial involvement at expert centres, considering the acceptable perioperative risk and the potential for prolonged survival.

The trial results indicate that multimodal imaging with ¹¹¹In-labelled dodecane tetra-acetic acid–labetuzumab-IRDye800CW can enhance future cancer treatment by significantly improving tumour detection and surgical precision. This technique allows the intraoperative identification of additional malignant lesions, leading to more thorough resections and potentially altering surgical strategies.

In the RAPIDO trial, total neoadjuvant therapy and chemoradiotherapy resulted in a similar incidence of perineal wound complications in patients with high-risk locally advanced rectal cancer who underwent abdominoperineal excision.